Question:
My insurance company has asked for a referral from a in network surgeon that does WLS

surgery to an surgeon that does the BPD/DS out of network. How likely is that to happen? I'm in florida and there are NO DS surgeons in the state. Have a question for y'all. What a surprise it was to call my PCP office the other day and find out they hadn't sent in the paperwork to the insurance yet. growl... I love kathy in his office, she is the insurance liason. She used to work with the only WLS surgeon in my town so she knows the ropes. She explained to me the best defense is go in fully loaded. So yesterday <friday> she sent to my HMO <BCBS_Health Options, an HMO> 26 pages of documentation. THAT got their attention, <laughing> The nurse called her back within an hour it was already on her desk. Now the rub, she said I of course would be approved,for a bypass but I had to see a surgeon in our network to refer me for the BPD/DS, they didn't even know what it was. Kathy gave me the direct fax to the nurse and I immediately faxed her <which was in the orignal material but I guess she couldn't find it> a description of the DS and comparisions to the RNY. I still have the appointment with the RNY doctor here, but have no idea of his feelings about the DS. or if he would refer me. Any suggestions? I would take the RNY and be bitterly dispointed but I really want the the DS, I feel its right for me. I'm forming my war plan and would appreciate any and all thoughts on this. Here or privately at [email protected] thanks very much. Debi in Florida pre-op BMI 46 Dr Gagner 1/18 pending insurance approval    — Debi V. (posted on December 30, 2000)

December 30, 2000
Debi, My surgery is scheduled on Jan.3rd with a surgeon who is not a WLS surgeon, rather his expertise is minimally invasive or laproscopic surgery. Be open to the surgeon's advice. I have worked in medicine for 23+ years and from doing an extensive amount of reading, and research it seems to be that alot of the RNY-v- DS surgery is really a matter of using different surgical techniques with similar outcomes.The training of bariatric surgeons and general surgeons is of course the same. The difference is the number of cases that WLS surgeons perform adds to their expertise. I feel very confident that the surgeon that will do my procedure has an expertise with the laproscope.Do not be "bitterly disappointed" and feel you are settling for RNY. I have gotten some great preop and postop advice from postings on this site, but most of the folks are not surgeons or experts and some of the discussion about surgical techniques and outcomes is not very accurate and subject to misinterpretation. Good Luck!
   — Margaret S.